NOMINATION FORM

*Award to be presented at the CABE/CAPSS Convention.

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* Nominee Name:

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* Daytime Phone:

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* Address:

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* Local or regional board of education:

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* Years of Service:

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* Other activities with the board:

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* Activities at the State level pertaining to education:

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* Activities at the National level pertaining to education:

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* Other comments or information:

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* Name of person submitting the nomination:

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* Daytime phone:

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* Board of education making the nomination:

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